Program Profile: Recovery Management Checkups for Women Offenders (Cook County, Ill.)

This intervention linked women who committed nonviolent offenses to community-based, substance use treatment after release from jail. It was designed to reduce recidivism and alcohol and drug use, and to promote long-term recovery. This program is rated Ineffective. The treatment group had a statistically significant greater likelihood of participating in substance use treatment; however, there were no significant effects for recidivism, alcohol and drug use, or number of days spent in jail.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Theory and Goals

Recovery Management Checkups for Women Offenders (RMC-WO) was based upon the recovery management checkup (RMC) model developed by Dennis, Scott, and Funk (2003). The intervention was designed to 1) engage women with substance use problems who had committed nonviolent offenses in the process of change, 2) assist them in understanding their behavior and becoming committed to behavioral change, and 3) assist them in learning to manage their behavior over time. To address the chronic nature of addiction, the RMC model promoted regular checkups (which facilitated early detection of relapse) and early re-intervention to reduce the time of reentry into treatment, and consequently, to improve long-term outcomes.

Targeted Population

The target population consisted of adult women with substance use problems who had committed nonviolent offenses, and were reentering the community from a county jail where they had participated in a substance use treatment program.

Program Components

RMC integrated components known to facilitate and sustain long-term recovery, including 1) continuous client engagement, 2) quarterly monitoring and linkage to treatment, 3) removing obstacles to treatment admission and recovery, 4) increasing treatment retention and completion, 5) teaching self-care skills, and 6) proactively resolving questions about drug and alcohol use and abstinence.

Women who participated in the intervention completed an initial interview at release with a linkage manager. During the first 90 days, checkups were scheduled for 30, 60, and 90 days after release and quarterly thereafter. Motivational interviewing was used to provide feedback regarding current substance use, HIV-risk behavior, or illegal activity; discuss barriers that prevented stopping each activity and ways to avoid them in the future; and discuss level of motivation for change.

As part of the monthly meetings, RMC participants received a modified gender-focused, HIV-risk reduction intervention that included 1) assessment and feedback on HIV behavior and knowledge and condom self-efficacy; 2) assistance in understanding related health conditions, 3) health promotion skills, and 4) HIV-risk reduction materials. After entering treatment, an engagement and retention protocol was implemented, which included a combination of phone calls and face-to-face visits during the first 14 days.

For women who reported current substance use, managers scheduled treatment appointments, accompanied them to intake, and remained with them throughout the process. For women entering detox, managers contacted them via phone or in person daily until they progressed to the next level of care. Linkage managers also arranged interventions to re-engage women who threatened to leave the program; failed to appear for an appointment; or developed an alternative action plan to improve substance use, HIV-risk behaviors, or illegal activity. For women not reporting any of these problem behaviors, the linkage manager and participant would develop a plan to maintain recovery.

Key Personnel/Training

All linkage managers were trained and certified on assessment, intervention, and tracking protocols. All interviews and linkage meetings were recorded and randomly selected for review to maintain high-quality data.

Study

Scott and Dennis (2012) conducted a randomized controlled trial to evaluate the impact of Recovery Management Checkups for Women Offenders (RMC-WO). The study assessed whether women who were assigned to participate in monthly recovery management checkups in the first 90 days following their release from jail had higher rates of participation in any substance use treatment program, and lower rates of drug and alcohol use, rearrest, and days in jail.

Between August 2008 and April 2010, women were recruited from the Department of Women’s Justice Services in the Cook County Jail, in Illinois, which operates residential and outpatient-based treatment programs as alternative sentencing for women who have been incarcerated for drug problems and who are considered nonviolent. Eligibility for this trial was determined in two phases. In the first phase, women were deemed ineligible if they had not used substances in the 90 days before incarceration, had no symptoms of dependence, were under 18, lived or planned to move outside Chicago within the next 12 months, were not fluent in English or Spanish, were cognitively unable to provide informed consent, or were released before the 14th day of incarceration. In the second phase, only women who had been released to the community were invited to participate in the trial. Of the 866 women eligible after Phase I, 810 women (93 percent) agreed to participate and completed the initial interview. After Phase II, 492 women were released to the community; of that number, 480 (98 percent) agreed to participate in the post-release randomized controlled trial.

There were 208 women randomly assigned to the RMC group and 242 to the control condition. The women were stratified into groups based on age (under versus over 35), African American (versus other races), having any prior treatment (versus none), receiving jail-based residential program (versus outpatient program), or scoring high on behavior-related testing (substance use disorder, HIV-risk behavior, crime/violence).

Eighty-three percent of the women described themselves as African American, followed by 8 percent white, 5 percent Hispanic, and 4 percent other. The average age was 37 years, and 22 percent started using alcohol or drugs before the age of 15. Ninety-four percent reported prior addiction treatments, 80 percent met criteria for dependence, and 43 percent reported symptoms consistent with one or more mental disorders. Current charges included alcohol or drugs, property crime, prostitution, violent crime, and criminal-justice-system violation. At release, 30 percent of women were on probation or parole, and 26 percent were mandated to treatment. There were no significant differences between treatment and control groups on any variables used to stratify.

Based upon the Global Appraisal of Individual Needs (Dennis et al. 2003), recidivism was measured using self-reports or Cook County’s Incarceration Management and Cost Recovery System as well as the state’s Law Enforcement Agencies Data System to check subsequent arrest and incarceration. Abstinence from drug and alcohol use was measured using urine test results or self-reporting. One hundred percent of the women completed the intake and release interviews. The regression analyses were conducted using data from the women, with one or more follow up (98 percent of the control group and 94 percent of the treatment group). No subgroup analyses were conducted.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Dennis, Michael L., Christy K. Scott, and Rod Funk. 2003. “An Experimental Evaluation of Recovery Management Checkups (RMC) for People with Chronic Substance Use Disorders.” Evaluation and Program Planning 26(3): 339–52.

Dennis, Michael L., Janet C. Titus, Michelle K. White, Joan I. Unsicker, and D. Hodgkins. 2003. “Global Appraisal of Individual Needs: Administration Guide for the GAIN and Related Measures.” Bloomington, Ill.: Chestnut Health Systems.